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Reducing the Language Accessibility GAP LANGUAGE SERVICES Torontos PROGRAM EVALUATION Reports CRICH Survey Research Units St

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Reducing the Language Accessibility GAP LANGUAGE SERVICES Torontos PROGRAM EVALUATION Reports CRICH Survey Research Units St reducing the language accessibility GAP LANGUAGE SERVICES TORONTOs PROGRAM EVALUATION REPORTs CRICH Survey Research Units St. Michael’s Hospitals July 18, 2014s This evaluation was designed and conducted by the Centre for Research on Inner City Health (CRICH) Survey Research Unit (SRU) at the request of the Toronto Central LHIN (TC LHIN). ABOUT TORONTO CENTRAL LHIN The Toronto Central LHIN is one of 14 regional authorities that are responsible for the planning, integration and funding of local health services. There are 170 health service providers in the Toronto Central LHIN that serve 1.15 million local residents and hundreds of thousands more who travel to this LHIN for care. LHINs are building a better health care system for people across Ontario by improving the patient experience in the health care system by working to remove the traditional silos between health care providers. ABOUT THE CRICH SURVEY RESEARCH UNIT The CRICH Survey Research Unit is housed at the Li Ka Shing Knowledge Institute, St. Michael’s Hospital. The SRU was created in July 2009 to consolidate, mobilize and expand CRICH’s considerable survey research capabilities and expertise. The Unit provides research and evaluation services to the health and social science community. For more information visit: http://sru.crich.ca. LEAD CONTRIBUTORS Dr. Patricia O’Campo, Kimberly Devotta, Dr. Tatiana Dowbor, Cheryl Pedersen ACKNOWLEDGMENTS The CRICH SRU would like to thank the patients and providers who participated in the evaluation, as well as providers who assisted with participant recruitment. Your insight and support is much appreciated. We would also like to thank Amy Katz and Jennifer (Sears) Miniota for reviewing the report, Rebecca Brown for assisting with interviewing and recruitment and Kawsika Sivayoganathan for assisting with interviewing. For more information about the evaluation please email [email protected] Table of Contents 1. EXECUTIVE SUMMARY 4 2. INTRODUCTION 5 Program description Program stakeholders Use of over-the-phone interpretation services in the health care setting—what the literature says 3. EVALUATION METHODOLOGY 8 Phase 1 – Qualitative exploratory interviews Phase 2 – Quantitative surveys Provider survey Patient survey Evaluation strengths and limitations Privacy and approvals 4. EVALUATION RESULTS 11 Impact of Language Service Toronto on other sources and modes of interpretation Appropriateness of LST program as a mode of interpretation Impact on service delivery Provider and patient satisfaction Identified areas for improvement and expansion of the LST program 5. SUMMARY OF ANSWERS 25 REFERENCES 26 APPENDICES 27 1. Executive Summary: Language Services Toronto Program Evaluation Report In 2012, the Toronto Central Local Health Integration Network (TC LHIN) created the Language Services Toronto (LST) program to provide an initial group of community and KEY FINDINGS health care organizations with greater access to professional over-the-phone interpreters so all patients could access care regardless of the language they spoke. Following the The Language Services Toronto program first year of LST implementation, the TC LHIN identified the has a strong impact on service accessibility need to evaluate the program before expanding to more and patient autonomy for patients with organizations within and outside the TC LHIN. limited or no English skills. The Survey Research Unit at the Centre for Research on Inner City Health at St. Michael’s Hospital designed and The LST program promoted a significant conducted the evaluation using a mixed-methods approach to shift from the utilization of ad-hoc, capture the perspectives of both patients and providers (e.g. nurses, physicians, administrative staff and managers) since non-professional interpretation the program’s initial implementation in October 2012. Data options to professional over-the-phone collection took place between June 2013 and May 2014. Close interpretation services. to 90 per cent of organizations that used the LST program during the evaluation period are represented in the data. The majority of patients and providers currently utilizing the LST program are satisfied with the services offered and reported improvements in different aspects of health care encounters (e.g. relationship, comfort, privacy). There is a need to continue to monitor service provision (e.g. wait times, languages offered, training materials). There is a need to complement LST with other interpretation strategies (e.g. accommodations for people who are hard of hearing, in-person, video conference) for certain types of visits and patient needs. 2. Introduction In July 2008, the Toronto Central Local Health Integration including 19 hospitals and 14 community agencies in the TC Network (TC LHIN) identified language as a systematic and LHIN and other neighboring LHINs. All health and community avoidable barrier to the equitable provision of health care ser- service providers, part of the TC LHIN coverage area, as well vices in Toronto. In 2010, the TC LHIN partnered with SickKids as providers from the surrounding LHIN geographies were to release a plan for action with the publication of the report invited to participate in the program, with funding committed Improving Health Equity through Language Access: A Model of for a small group of early adopter TC LHIN community-sector Integrated Language Services throughout Toronto central LHIN.ii organizations. Improved access to language supports was identified as a pri- ority in the Hospital Health Equity Plans, in the consultations for the 2010-2013 Integrated Health Services Plan – (IHSP-2), and also during the health equity consultation that took place in the TC LHIN in the spring of 2011. In October 2012, the TC LHIN launched the Language Services Toronto (LST) program to provide over-the-phone interpretation services to hospitals and community agencies within its network. After one year of implementation and with plans to expand the program, the TC LHIN engaged the Centre for Research on Inner City Health (CRICH) at St. Michael’s Hospital to conduct an evalu- ation. The evaluation was designed and conducted by the CRICH Survey Research Unit (SRU). The findings from this mixed-methods evaluation are presented in this report. Evaluation questions Figure 1: Geographic area of the Toronto Central LHIN What was the impact of the LST program on the Prior to LST, hospitals within the TC LHIN had identified interpretation services offered? translation and interpretation services as an area to be Is over-the-phone interpretation an appropriate addressed in their health equity plans. Hospitals and other mode for the LST program? organizations within the TC LHIN had varying usage rates – in some cases, none at all – for interpretation services. What was the impact of the LST program on service The main objectives of the LST program are (1) to eliminate delivery? language barriers to accessing quality service and (2) to improve health outcomes by ensuring increased accurate Are patients and providers satisfied with the communication between providers and patients through the program? use of professionally-trained interpreters. What aspects of the program should be improved and/or expanded? “All patients should receive high quality care, regardless of the PROGRAM DESCRIPTION languages they speak or sign.” The Languages Services Toronto (LST) program provides -TC LHIN real-time, over-the-phone interpretation (OPI) services in 170 languages, 24 hours a day, seven days a week to clients LST provides on-demand access to telephone interpreters utilizing health care services in participating organizations. for various health and social service-related interactions. For The program launched in October 2012, with the first phase example, telephone interpreters can be used by a medical 5 secretary booking an appointment over the phone; a health Health Centres. Hospitals within the TC LHIN, as well as care provider answering a follow-up question over the phone; hospitals and organizations outside the TC LHIN area, benefit and a provider conducting an in-person appointment. Users can from the group rate and program coordination, but use their include intake workers, primary care providers, etc. own budgets to pay for the services. Using a dual-handset device, speakerphone or teleconferencing phone feature, patients/clients with limited English can communicate with providers and other health care staff in their Program stakeholders preferred language. Services are accessed through one central phone number that is answered by the RIO Network (a division The TC LHIN leads the LST program as the executive of Access Alliance Language Services). Callers are prompted sponsor. to key in the needed language and are then transferred to a RIO interpreter if one is available. In the event that a RIO The University Health Network (UHN) is the interpreter is not available, callers are automatically transferred operational lead organization. It represents the to Language Line Services to be connected with an interpreter. consortium of participating sites, maintains the In the case of rare languages, to ensure availability, staff can service contract with the vendor and provides call ahead and pre-book an interpreter. Each organization is training to program users. provided with an access code when they sign onto the program. A steering committee provides oversight for The code is keyed in by providers when accessing the services the program as well as strategic direction. The and used to track organization
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